Острая надпочечниковая недостаточность в детском возрасте: этиопатогенез, клиника, интенсивная терапия

Введение. Острая надпочечниковая недостаточность (ОНН) — тяжелая эндокринопатия, поражающая пациентов, в т. ч. детей и подростков, с невысокими показателями заболеваемости, но потенциальным риском развития летального исхода. Рассмотрение вопросов оказания неотложной помощи детям с этой патологией является актуальным направлением детской анестезиологии-реаниматологии.
Цель работы — определение современного состояния проблемы этиопатогенеза, клинико-лабораторной диагностики и интенсивной терапии при ОНН в детском возрасте.
Материалы и методы. Выполнен поиск и анализ научных работ с использованием баз данных Cochrane Library, PubMed и Medscape по поисковым словам: «острая надпочечниковая недостаточность, дети и подростки, глюкокортикоиды, интенсивная терапия, инфузионная терапия». Для обзора отобрано 65 источников.
Результаты и обсуждение. Патофизиология ОНН обусловлена резким дефицитом кортизола (и минералокортикоидов), который запускает воспалительную реакцию, электролитный дисбаланс и гемодинамические нарушения. Клинические проявления ОНН включают в себя признаки эксикоза, тошноту, рвоту, болевой синдром, снижение артериального давления, тахикардию, судороги и нарушение сознания вплоть до комы. При лабораторном исследовании у детей часто диагностируются гиперкалиемия, гипонатриемия, гипогликемия и гиперкальциемия. Основой интенсивной терапии в отделении анестезиологии и реанимации при ОНН является парентеральное введение ГК (препарат выбора — гидрокортизон, внутривенно). При стабилизации состояния ребенка спустя 2–3 дня производят перевод на пероральные формы гормонов. Параллельно осуществляется инфузионная терапия для повышения объема циркулирующей крови и купирования эксикоза за счет назначения кристаллоидных растворов длительностью до 2–3 дней.
Заключение. Более полное понимание аспектов этиопатогенеза, клинических проявления и диагностических особенностей при ОНН, а также знание алгоритмов неотложной помощи позволят повысить качество оказания экстренной помощи при рассматриваемой патологии в педиатрической практике.

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